{"id":344796,"date":"2025-05-24T07:38:12","date_gmt":"2025-05-24T06:38:12","guid":{"rendered":"https:\/\/zakrasnejsivimperk.cz\/?p=344796"},"modified":"2025-05-24T14:10:30","modified_gmt":"2025-05-24T13:10:30","slug":"v-cr-se-rychle-siri-zloutenka-a-kontakt-s-infikovanym-muze-ohrozit-i-plany-deti-na-prazdniny","status":"publish","type":"post","link":"https:\/\/zakrasnejsivimperk.cz\/?p=344796","title":{"rendered":"AKTU\u00c1LN\u011a: V \u010cR se rychle \u0161\u00ed\u0159\u00ed \u017eloutenka A. Kontakt s infikovan\u00fdm m\u016f\u017ee ohrozit i pl\u00e1ny d\u011bt\u00ed na pr\u00e1zdniny"},"content":{"rendered":"
Takzvanou nemoc\u00ed \u0161pinav\u00fdch rukou se letos za prvn\u00ed 4 m\u011bs\u00edce roku nakazilo u\u017e 450 lid\u00ed. 6 z nich infekci hepatitidou A (VHA) podlehlo. Onemocn\u011bn\u00ed, zn\u00e1m\u00e9 tak\u00e9 pod n\u00e1zvem infek\u010dn\u00ed \u017eloutenka, se krom\u011b d\u011btsk\u00e9 populace \u0161\u00ed\u0159\u00ed tak\u00e9 mezi dosp\u00edvaj\u00edc\u00edmi a mlad\u00fdmi dosp\u011bl\u00fdmi, a d\u00e1le mezi lidmi s rizikov\u00fdm chov\u00e1n\u00edm, p\u0159edev\u0161\u00edm mezi z\u00e1visl\u00fdmi na drog\u00e1ch a mezi lidmi bez domova. K p\u0159enosu doch\u00e1z\u00ed hlavn\u011b v d\u016fsledku \u0161patn\u00fdch hygienick\u00fdch podm\u00ednek. Je d\u016fle\u017eit\u00e9 otev\u0159\u00edt diskusi o mo\u017enostech \u00fahrady o\u010dkov\u00e1n\u00ed proti \u017eloutence A, upozor\u0148uje hlavn\u00ed hygieni\u010dka. Hygienick\u00e9 stanice varuj\u00ed, \u017ee \u017eloutenka m\u016f\u017ee mnoha lidem p\u0159ekazit i pl\u00e1ny na pr\u00e1zdniny a dovolen\u00e9.<\/h6>\n

\"\"U\u017e data v lo\u0148sk\u00e9m roce, kdy jsme zaznamenali 636 infikovan\u00fdch v\u010detn\u011b dvou \u00famrt\u00ed, ukazovala na postupn\u00e9 \u0161\u00ed\u0159en\u00ed n\u00e1kazy nap\u0159\u00ed\u010d celou republikou a tento trend bohu\u017eel pokra\u010duje.<\/p>\n

\u201eKdy\u017e srovn\u00e1me \u010d\u00edsla za cel\u00fd lo\u0148sk\u00fd a jen \u010dty\u0159i m\u011bs\u00edce leto\u0161n\u00edho roku, je z\u0159ejm\u00e9, \u017ee vid\u00edme prudk\u00fd n\u00e1r\u016fst p\u0159\u00edpad\u016f. Onemocn\u011bn\u00ed hepatitidou typu A se t\u00fdkaj\u00ed kraj\u016f nap\u0159\u00ed\u010d republikou. Nejv\u00edce hl\u00e1s\u00ed kraje St\u0159edo\u010desk\u00fd \u2013 87, Moravskoslezsk\u00fd – 83 a Praha – 73 p\u0159\u00edpady. V populaci postupn\u011b nar\u016fst\u00e1 po\u010det vn\u00edmav\u00fdch jedinc\u016f, tedy t\u011bch, kte\u0159\u00ed se s onemocn\u011bn\u00edm dosud nesetkali, nebo nejsou o\u010dkovan\u00ed. Maj\u00ed tak v\u011bt\u0161\u00ed pravd\u011bpodobnost se p\u0159i styku s infikovanou osobou nebo p\u0159edm\u011bty nakazit. \u0160\u00ed\u0159en\u00ed VHA bylo krom\u011b d\u011btsk\u00e9 populace zaznamen\u00e1no tak\u00e9 v populaci dosp\u00edvaj\u00edc\u00edch a mlad\u00fdch dosp\u011bl\u00fdch a d\u00e1le osob s rizikov\u00fdm chov\u00e1n\u00edm, p\u0159edev\u0161\u00edm mezi z\u00e1visl\u00fdmi na drog\u00e1ch a lidmi bez domova. K p\u0159enosu n\u00e1kazy doch\u00e1z\u00ed hlavn\u011b v d\u016fsledku \u0161patn\u00fdch hygienick\u00fdch podm\u00ednek. Vzhledem k dlouh\u00e9 inkuba\u010dn\u00ed dob\u011b, \u010dasto bezp\u0159\u00edznakov\u00e9mu pr\u016fb\u011bhu, mno\u017e\u00edc\u00edmu se nedodr\u017eov\u00e1n\u00ed na\u0159\u00edzen\u00fdch protiepidemick\u00fdch opat\u0159en\u00ed i z\u00e1kladn\u00edch hygienick\u00fdch n\u00e1vyk\u016f, m\u00e1 n\u00e1kaza velmi dobr\u00e9 podm\u00ednky k \u0161\u00ed\u0159en\u00ed,\u201c<\/em> vysv\u011btluje p\u0159\u00ed\u010diny hlavn\u00ed hygieni\u010dka a \u0159editelka SZ\u00da MUDr. Barbora Mackov\u00e1, MHA.<\/p>\n

\u201eNa \u00fazem\u00ed Prahy je t\u00e9m\u011b\u0159 1\/3 onemocn\u011bn\u00ed hl\u00e1\u0161ena u osob bez domova, z nich\u017e v\u011bt\u0161ina jsou z\u00e1rove\u0148 u\u017eivatel\u00e9 drog. U t\u011bchto osob je velmi slo\u017eit\u00e9 nastavit dodr\u017eov\u00e1n\u00ed protiepidemick\u00fdch opat\u0159en\u00ed a zejm\u00e9na vyhled\u00e1v\u00e1n\u00ed kontakt\u016f je problematick\u00e9, ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f se n\u00e1m nepoda\u0159\u00ed kontakty dohledat. Proto jsme dodali o\u010dkovac\u00ed l\u00e1tku do center Nad\u011bje a Arm\u00e1dy sp\u00e1sy, kde pracovn\u00edci aktivn\u011b nab\u00edzej\u00ed klient\u016fm tuto ochranu zdarma. Tato centra z\u00e1rove\u0148 spolupracuj\u00ed p\u0159i dohled\u00e1v\u00e1n\u00ed kontakt\u016f,\u201c<\/em> potvrzuje \u0159editelka protiepidemick\u00e9ho odboru Hygienick\u00e9 stanice hlavn\u00edho m\u011bsta Prahy MUDr. Martina Mare\u0161ov\u00e1 a dopl\u0148uje, \u017ee v Praze prob\u00edh\u00e1 tak\u00e9 o\u010dkov\u00e1n\u00ed ter\u00e9nn\u00edch pracovn\u00edk\u016f, kte\u0159\u00ed p\u0159ich\u00e1zej\u00ed do \u00fazk\u00e9ho kontaktu pr\u00e1v\u011b s osobami \u017eij\u00edc\u00edmi na ulici a u\u017eivateli drog, pom\u00e1haj\u00ed jim se zaji\u0161t\u011bn\u00edm p\u0159echodn\u00e9ho ubytov\u00e1n\u00ed, \u010di \u0159e\u0161\u00ed jejich zdravotn\u00ed probl\u00e9my.<\/p>\n

Co se t\u00fdk\u00e1 \u010dasto dotazovan\u00e9 \u010d\u00edseln\u00e9 hranice pro stav epidemie, nen\u00ed stanovena. Ze zku\u0161enost\u00ed ale v\u00edme, \u017ee i jeden potvrzen\u00fd p\u0159\u00edpad m\u016f\u017ee n\u00e1sledn\u011b znamenat velk\u00fd probl\u00e9m. U \u017eloutenky typu A v\u011bt\u0161ina p\u0159\u00edpad\u016f, zejm\u00e9na u d\u011bt\u00ed, prob\u00edh\u00e1 bez p\u0159\u00edznak\u016f, a lid\u00e9 jsou infek\u010dn\u00ed u\u017e zhruba od poloviny inkuba\u010dn\u00ed doby. Naka\u017een\u00fdch je tak s nejv\u011bt\u0161\u00ed pravd\u011bpodobnost\u00ed mnohem v\u00edce a tedy ka\u017ed\u00fd p\u0159\u00edpad je pro epidemiology varov\u00e1n\u00edm.<\/p>\n

\u201eInkuba\u010dn\u00ed doba virov\u00e9 hepatitidy A, tedy doba od n\u00e1kazy \u010dlov\u011bka do rozvinut\u00ed p\u0159\u00edznak\u016f onemocn\u011bn\u00ed, je 14 \u2013 50 dn\u00ed, nej\u010dast\u011bji 30 dn\u00ed. Obdob\u00ed naka\u017elivosti za\u010d\u00edn\u00e1 ji\u017e ve druh\u00e9 polovin\u011b inkuba\u010dn\u00ed doby, kdy je ji\u017e virus p\u0159\u00edtomen ve stolici, tedy zpravidla 1 a\u017e 2 t\u00fddny p\u0159ed za\u010d\u00e1tkem samotn\u00e9ho onemocn\u011bn\u00ed. Naka\u017elivost pak trv\u00e1 1 a\u017e 2 t\u00fddny po za\u010d\u00e1tku onemocn\u011bn\u00ed. \u0160\u00ed\u0159en\u00ed VHA je nej\u010dast\u011bj\u0161\u00ed stolic\u00ed infikovan\u00e9ho \u010dlov\u011bka. Jedn\u00e1 se jak o p\u0159enos p\u0159\u00edm\u00fd, od osoby k osob\u011b, nap\u0159\u00edklad \u0161pinav\u00fdma rukama, tak i nep\u0159\u00edm\u00fd, zne\u010di\u0161t\u011bnou vodou nebo potravinami a zne\u010di\u0161t\u011bn\u00fdmi p\u0159edm\u011bty, nap\u0159\u00edklad hovo\u0159\u00edme o klik\u00e1ch dve\u0159\u00ed, madlech, dr\u017eadlech, zkr\u00e1tka o \u010dasto lidmi dot\u00fdkan\u00fdch m\u00edstech,\u201c<\/em> popisuje z\u00e1stupkyn\u011b vedouc\u00edho Odd\u011blen\u00ed epidemiologie infek\u010dn\u00edch nemoc\u00ed SZ\u00da, MUDr. Kate\u0159ina Fabi\u00e1nov\u00e1, Ph.D.<\/p>\n

U v\u011bt\u0161iny p\u0159\u00edpad\u016f je pr\u016fb\u011bh onemocn\u011bn\u00ed v dosp\u011blosti z\u00e1va\u017en\u011bj\u0161\u00ed ne\u017e v d\u011btsk\u00e9m v\u011bku, kdy obvykle prob\u00edh\u00e1 bez p\u0159\u00edznak\u016f, a proto se snadno \u0161\u00ed\u0159\u00ed. Asi u 10 % pacient\u016f v\u0161ak doch\u00e1z\u00ed ke komplikovan\u00fdm pr\u016fb\u011bh\u016fm; onemocn\u011bn\u00ed i rekonvalescence pak trvaj\u00ed i n\u011bkolik m\u011bs\u00edc\u016f. Zcela v\u00fdjime\u010dn\u011b m\u016f\u017ee doj\u00edt k tzv. fulminantn\u00edmu, velmi prudk\u00e9mu pr\u016fb\u011bhu, vedouc\u00edmu k jatern\u00edmu selh\u00e1n\u00ed a smrti. Smrtnost je celkov\u011b n\u00edzk\u00e1 (0,1\u20130,3 %), ale m\u016f\u017ee b\u00fdt vy\u0161\u0161\u00ed (1,8 %) u dosp\u011bl\u00fdch nad 50 let, nebo osob se z\u00e1kladn\u00edm chronick\u00fdm onemocn\u011bn\u00edm jater.<\/p>\n

Negativn\u00ed trend prudk\u00e9ho \u0161\u00ed\u0159en\u00ed VHA se v \u010cesk\u00e9 republice rozhodn\u011b nezastav\u00ed ze dne na den. Proto je t\u0159eba, aby lid\u00e9 o riziku v\u011bd\u011bli, aby znovu za\u010dali d\u016fsledn\u011b db\u00e1t na prevenci. Z\u00e1kladem je d\u016fsledn\u00e1 hygiena, k dispozici je i o\u010dkov\u00e1n\u00ed. O\u010dkov\u00e1n\u00ed v \u010cR nen\u00ed povinn\u00e9 ani hrazen\u00e9, nicm\u00e9n\u011b mnoho zdravotn\u00edch poji\u0161\u0165oven na n\u011bj v programech prevence p\u0159isp\u00edv\u00e1 a tato investice, kter\u00e1 p\u0159edstavuje zhruba sedmn\u00e1ct set korun do jedn\u00e9 vakc\u00edny, se rozhodn\u011b vyplat\u00ed.<\/p>\n

\u201eKrajsk\u00e9 hygienick\u00e9 stanice mohou na z\u00e1klad\u011b vyhodnocen\u00ed situace ve sv\u00e9m regionu na\u0159\u00eddit v r\u00e1mci \u0161et\u0159en\u00ed mimo\u0159\u00e1dn\u00e9 o\u010dkov\u00e1n\u00ed. Tento n\u00e1stroj ji\u017e vyu\u017e\u00edvaj\u00ed, a pokud se takov\u00e9 o\u010dkov\u00e1n\u00ed kon\u00e1, pak je vakc\u00edna lidem hrazen\u00e1,\u201c<\/em> p\u0159ipom\u00edn\u00e1 n\u00e1stroj prevence v zasa\u017een\u00fdch lokalit\u00e1ch hlavn\u00ed hygieni\u010dka.<\/p>\n

V \u010cesk\u00e9 republice jsou k dispozici bezpe\u010dn\u00e9 a \u00fa\u010dinn\u00e9 o\u010dkovac\u00ed l\u00e1tky pro d\u011bti a dosp\u011bl\u00e9. Z\u00e1kladn\u00ed ochrany je dosa\u017eeno po jedn\u00e9 injek\u010dn\u011b podan\u00e9 d\u00e1vce. K z\u00edsk\u00e1n\u00ed dlouhodob\u00e9 ochrany je nutn\u00e9 p\u0159eo\u010dkov\u00e1n\u00ed druhou d\u00e1vkou, kter\u00e9 se prov\u00e1d\u00ed za 6 \u2013 18 m\u011bs\u00edc\u016f po pod\u00e1n\u00ed prvn\u00ed d\u00e1vky.<\/p>\n

Jak\u00e1 jsou protiepidemick\u00e1 opat\u0159en\u00ed p\u0159i v\u00fdskytu VHA? Z\u00e1kladn\u00edm opat\u0159en\u00edm je izolace nemocn\u00e9ho, zpravidla na infek\u010dn\u00edm odd\u011blen\u00ed. P\u0159i nahl\u00e1\u0161en\u00ed onemocn\u011bn\u00ed provedou zam\u011bstnanci hygienick\u00e9 slu\u017eby s nemocn\u00fdm epidemiologick\u00e9 \u0161et\u0159en\u00ed, ve kter\u00e9m se zam\u011b\u0159uj\u00ed na to, kde a jak mohlo doj\u00edt k p\u0159enosu n\u00e1kazy. D\u00e1le se vyhled\u00e1vaj\u00ed kontakty, kter\u00e9 mohl pacient nakazit. Kontakt\u016fm se vyd\u00e1v\u00e1 tzv. l\u00e9ka\u0159sk\u00fd dohled, v r\u00e1mci kter\u00e9ho jsou po dobu maxim\u00e1ln\u00ed inkuba\u010dn\u00ed doby (50 dn\u00ed) sledov\u00e1ni a vy\u0161et\u0159ov\u00e1ni. Pokud od posledn\u00edho kontaktu s nemocn\u00fdm neuplyne doba del\u0161\u00ed ne\u017e 14 dn\u00ed, nab\u00edz\u00ed se tak\u00e9 o\u010dkov\u00e1n\u00ed, kter\u00e9 je\u0161t\u011b m\u016f\u017ee onemocn\u011bn\u00ed zabr\u00e1nit, ev. zm\u00edrnit jeho pr\u016fb\u011bh. Pro p\u0159edstavu, na z\u00e1klad\u011b epidemiologick\u00e9ho \u0161et\u0159en\u00ed a trasov\u00e1n\u00ed kontakt\u016f bylo pracovn\u00edky epidemiologie z hygienick\u00fdch stanic zaznamen\u00e1no celkem 6 375 kontakt\u016f v cel\u00e9 \u010cR jen za lo\u0148sk\u00fd rok.<\/p>\n

\u201eV r\u00e1mci l\u00e9ka\u0159sk\u00e9ho dohledu jsou osob\u00e1m v kontaktu zak\u00e1z\u00e1ny tak\u00e9 ur\u010dit\u00e9 \u010dinnosti, nap\u0159. n\u00e1v\u0161t\u011bva baz\u00e9nu, saun a u d\u011bt\u00ed tak\u00e9 \u00fa\u010dast na hromadn\u011b organizovan\u00fdch akc\u00edch, jako jsou letn\u00ed t\u00e1bory a r\u016fzn\u00e1 soust\u0159ed\u011bn\u00ed. Tato opat\u0159en\u00ed se net\u00fdkaj\u00ed d\u011bt\u00ed, kter\u00e9 jsou \u0159\u00e1dn\u00e9 o\u010dkovan\u00e9. U osob proo\u010dkovan\u00fdch se l\u00e9ka\u0159sk\u00fd dohled nevyd\u00e1v\u00e1 a tito lid\u00e9 nemaj\u00ed \u017e\u00e1dn\u00e1 omezen\u00ed. Proto doporu\u010dujeme za sou\u010dasn\u00e9 epidemiologick\u00e9 situace, p\u0159ed n\u00e1stupem dovolen\u00fdch a pr\u00e1zdnin, se nechat nao\u010dkovat. Z na\u0161\u00ed praxe v\u00edme o mnoh\u00fdch smutn\u00fdch p\u0159\u00edb\u011bz\u00edch, kdy jsme nemohli pustit d\u011bti na t\u00e1bory, proto\u017ee v jejich t\u0159\u00edd\u011b se vyskytla \u017eloutenka,\u201c<\/em> varuje p\u0159ed rizikem, \u017ee infekce zkaz\u00ed pl\u00e1ny na pr\u00e1zdniny a dovolen\u00e9 MUDr. Martina Mare\u0161ov\u00e1.<\/p>\n

\u0160\u00ed\u0159en\u00ed \u017eloutenky typu A se ale net\u00fdk\u00e1 jen \u010cR, podobn\u00fd v\u00fdvoj hl\u00e1s\u00ed i dal\u0161\u00ed evropsk\u00e9 st\u00e1ty, jako nap\u0159\u00edklad Slovensko nebo Ma\u010farsko. Hl\u00e1\u0161en\u00e9 p\u0159\u00edpady VHA jsou aktu\u00e1ln\u011b i z Irska nebo Velk\u00e9 Brit\u00e1nie. Je proto mimo\u0159\u00e1dn\u011b d\u016fle\u017eit\u00e9 zejm\u00e9na na za\u010d\u00e1tku cestovatelsk\u00e9 sez\u00f3ny db\u00e1t na prevenci!<\/p>\n

\u201eZejm\u00e9na u cestovatel\u016f je doporu\u010deno vyvarovat se konzumace syrov\u00fdch sal\u00e1t\u016f a zeleniny, ovoce, kter\u00e9 si sami neoloupete, zmrzliny, mo\u0159sk\u00fdch plod\u016f v syrov\u00e9m nebo polosyrov\u00e9m stavu a nebezpe\u010dn\u00e9 jsou obzvl\u00e1\u0161t\u011b \u00fast\u0159ice. V\u0161eobecn\u011b je dobr\u00e9 se vyh\u00fdbat pokrm\u016fm nedostate\u010dn\u011b tepeln\u011b upraven\u00fdm a nepou\u017e\u00edvat led do n\u00e1poj\u016f. Zejm\u00e9na v zem\u00edch s ni\u017e\u0161\u00edm hygienick\u00fdm standardem se nedoporu\u010duje pou\u017e\u00edvat vodu z ve\u0159ejn\u00e9ho vodovodu, a to ani k \u010di\u0161t\u011bn\u00ed zub\u016f. Je dobr\u00e9 se \u0159\u00eddit z\u00e1kladn\u00edm pravidlem Sv\u011btov\u00e9 zdravotnick\u00e9 organizace pro p\u0159\u00edpravu potravy v exotick\u00fdch zem\u00edch: p\u0159eva\u0159it, up\u00e9ct, oloupat, nebo nechat b\u00fdt,\u201c<\/em> p\u0159ipom\u00edn\u00e1 doktorka Fabi\u00e1nov\u00e1.<\/p>\n

Opakujeme, \u017ee za nejlep\u0161\u00ed preventivn\u00ed opat\u0159en\u00ed je mo\u017en\u00e9 ozna\u010dit o\u010dkov\u00e1n\u00ed, ide\u00e1ln\u011b v d\u011btsk\u00e9m v\u011bku, proto\u017ee \u00fapln\u00e9 o\u010dkov\u00e1n\u00ed chr\u00e1n\u00ed dlouhodob\u011b. O\u010dkov\u00e1n\u00ed je doporu\u010dov\u00e1no zejm\u00e9na osob\u00e1m vystaven\u00fdm zv\u00fd\u0161en\u00e9mu riziku n\u00e1kazy hepatitidou A v r\u00e1mci sv\u00e9ho povol\u00e1n\u00ed, d\u00e1le cestuj\u00edc\u00edm do oblast\u00ed s vysok\u00fdm v\u00fdskytem t\u00e9to infekce, osob\u00e1m s chronick\u00fdm onemocn\u011bn\u00edm jater, bl\u00edzk\u00fdm kontakt\u016fm s nemocn\u00fdmi, stejn\u011b jako osob\u00e1m s rizikov\u00fdm chov\u00e1n\u00edm umo\u017e\u0148uj\u00edc\u00edm \u0161\u00ed\u0159en\u00ed viru. Krom\u011b o\u010dkov\u00e1n\u00ed je nezbytnou sou\u010d\u00e1st\u00ed prevence tak\u00e9 zvy\u0161ov\u00e1n\u00ed a dodr\u017eov\u00e1n\u00ed osobn\u00ed hygieny a osv\u011bta zam\u011b\u0159en\u00e1 na zp\u016fsoby p\u0159enosu.<\/p>\n

\u201eV souvislosti s p\u0159\u00edpravou nov\u00e9ho syst\u00e9mu vstupu vakc\u00edn na trh vid\u00edm vzhledem k aktu\u00e1ln\u00ed epidemiologick\u00e9 situaci jako d\u016fle\u017eitou diskusi o mo\u017enostech \u00fahrady o\u010dkov\u00e1n\u00ed proti \u017eloutence A. Ji\u017e je diskutov\u00e1na v r\u00e1mci odborn\u00fdch kruh\u016f a zah\u00e1j\u00edme ji na \u00farovni MZ a zdravotn\u00edch poji\u0161\u0165oven,\u201c<\/em> nast\u00ednila vhodn\u00e9 \u0159e\u0161en\u00ed do budoucna hlavn\u00ed hygieni\u010dka.<\/p>\n

Text a p\u0159\u00edlohy: (tz-sz\u00fa)<\/strong><\/p>\n

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